Endoscopic operation techniques have become accepted for a multitude of surgical interventions. As opposed to conventional open operations, a substantial advantage of endoscopic operations is that a large incision into the skin and into subjacent tissue for making the surgical field accessible can be dispensed with, in which way a considerable strain of the patient can be avoided and the duration of in-patient treatment can be reduced. Instead, for example in endoscopic interventions in the abdominal cavity, endoscopes and/or endoscopic instruments are introduced through one or several shorter incisions towards the surgical field, where, for example by gas insufflation, a hollow space can be created, within which the surgical manipulations required for performing the intervention, can be conducted. After conducting the manipulations, the endoscopes and/or endoscopic instruments are removed from the abdominal cavity and the cut-through tissue layers are closed, for example by surgical sutures. Although the incisions and therefore the required sutures are relatively short in such laparoscopic interventions, nevertheless possibly scars may remain.
In order to further reduce the patient's strain in surgical interventions in the abdominal cavity, a surgical technique has been developed known under the term NOTES (Natural Orifice Transluminal Endoscopic Surgery), in which the endoscopes and/or endoscopic instruments are introduced through natural orifices such as the pharynx, the esophagus and the stomach (see www.wikipedia.de, headword “NOTES”, of Dec. 6, 2010). Through a small incision in the stomach wall, the actual surgical field in the abdominal cavity, for example the gall bladder, can be accessed. As the stomach wall comprises fewer pain receptors than normal skin, in this way the administration of anesthetics can be reduced, further reducing the patient's recovery time. Moreover, the effect of gastric acid can be employed for the prevention of infections. Finally, visible scars can be completely or, if an additional endoscopic access through the body surface is necessitated, at least partially avoided. Endoscopes for performing operations according to the NOTES method are known, for example, from the published applications US 2008/0269562 A1 and US 2009/0054733 A1, which are herewith included in the present application by reference.
After the manipulations inside the abdominal cavity have been performed and the endoscopes and/or endoscopic instruments have been removed from the surgical field, the incision in that organ that constitutes the natural access, for example in the wall of the stomach, is to be closed again. During the actual surgical intervention it may be necessary as well to close tissue openings and/or to connect tissue margins to each other. For this purpose, various techniques are known, such as, for example, clips, tissue anchors, or clamps. However, such techniques not only involve considerable instrumental complexity, but also exhibit the disadvantage, for example, that after the operation at first there remains a foreign body which, due to its mechanical properties, may obstruct the normal function of the stomach wall. Moreover, possible applications of such closing means are limited. Closing the entrance port is thus a problem which so far is not satisfactorily solved in the NOTES method. The incision in the wall of the access organ therefore frequently is not closed at all.
Thus, it would be desirable if an endoscopic instrument system for performing operations via a natural access path (NOTES) were available which is improved in respect to closing the incision in the wall of the access organ. Such closing could be performed, in particular, by a surgical suture of that kind employed for closing an incision in the body surface or in soft tissue close to the surface. The feasibility of providing a suture within such an operation, however, has been very limited up to now.
For providing such sutures, in particular, in operations which can be performed with rigid endoscopes, needle holders for gripping surgical needles are known. These may be designed straight, straight with a curved tip, curved, or part-circular, and are moved approximately on a circular trajectory for performing a stitch and for pulling a surgical thread through the tissue margins to be connected to each other. In order to accomplish this, depending on the kind and the thickness of the tissue and on the kind of the needle, a considerable angular momentum may be required.
Within the framework of the NOTES method flexible endoscopic instruments are employed. In order to increase the rotational stiffness of the shaft, it may be, for example, designed as a wire spiral or be provided with another kind of reinforcement. Nevertheless, in known endoscopic instruments to be employed in flexible endoscopes for performing an operation according to the NOTES method, the angular momentum that can be transferred frequently is not sufficient for a corresponding handling for piercing tissue with a surgical needle, due to the flexibility of the instrument. In other kinds of manipulations, for example for cutting hard tissues, the force and/or the angular momentum that can be exerted with such instruments is not always sufficient for a rapid and safe accomplishment of the operation.